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Medical neutrality and modern war

I expect most readers know how the International Committee of the Red Cross had its origins in Henry Dunant‘s horror at the unrelieved suffering he witnessed in the aftermath of the Battle of Solferino in 1859 (see my earlier post here).

In A Memory of Solferino (1862) he asked: ‘Would it not be possible, in time of peace and quiet, to form relief societies for the purpose of having care given to the wounded in wartime by zealous, devoted and thoroughly qualified volunteers?’

Dunant’s vision of an impartial relief society to provide aid to those wounded in time of war led to the formation of a series of national relief societies and, as John Hutchinson shows in Champions of Charity: War and the rise of the Red Cross, these national societies soon became entangled with nationalism. ‘Gripped by the passions of patriotism,’ he writes, by the time of the First World War these national societies ‘undertook to perform whatever repair work the armies required of them.’

And yet, even with these entanglements, a key principle was defended: medical neutrality. According to Physicians for Human Rights, medical neutrality requires:

The protection of medical personnel, patients, facilities, and transport from attack or interference;

Unhindered access to medical care and treatment;

The humane treatment of all civilians; and

Nondiscriminatory treatment of the sick and injured.

During the First World war there were complaints that the principle had been sporadically violated: that stretcher-bearers had been attacked by snipers when they sought to recover the wounded or that military hospitals had been deliberately shelled or bombed. Here, for example, is the aftermath of one of several air raids targeting base hospitals at Etaples on the French coast between May and August 1918 (supposedly in retaliation for a British air raid on Cologne):

But in the last decade of our own century such violations have become increasingly systematic. And, as more and more civilians have become trapped and even targeted in conflict zones whose ‘battlefields’ know no bounds, so those violations have extended far beyond attacks on military-medical infrastructure and personnel.

Last summer I detailed the attacks made by the Israeli military on medical facilities and emergency systems in Gaza, and I drew attention to the work of Physicians for Human Rights in documenting the precariousness of medical care there. But the calculated production of these spaces of exception is not exceptional, and attacks like these have become part of the arsenal of later modern war. “Instead of being protected,” says Donna McKay, executive director of PHR, “medical care is actually a target.”

Over the past year armed groups have attacked hospitals, clinics, and health personnel in 41 incidents in Afghanistan and deliberately killed over 45 health workers, primarily polio vaccinators, in Nigeria and Pakistan. In Syria, where medical facilities in Aleppo have been hit with government barrel bombs, 194 medical personnel have been killed and 104 medical facilities attacked since 2014….

The organizations described attacks in South Sudan, where 58 people were killed in four hospitals in a series of attacks in early 2014, and in eastern Ukraine, where it is estimated that 30 to 70 percent of health workers have fled the region because of insecurity. In Yemen, Al-Qaeda in the Arabian Peninsula (AQAP) militants carried out attacks on health facilities in early 2014, and the 10-country Saudi-led coalition conducted air strikes that hit hospitals and interrupted medical supplies during the conflict in early 2015. Relying on data from Insecurity Insight’s Security in Numbers Database, the report also shows trends in attacks on health care over the course of a decade in South Sudan and Central African Republic.

In close concert with the report Physicians for Human Rights have produced an interactive online map of attacks on health care around the world between January 2014 and April 2015 (see the screenshot above).

The symbols of the Red Cross and Red Crescent have been turned from a shield of protection into crosshairs on the backs of those who knowingly risk their lives to save others.

You can find more on the violation of medical neutrality in Syria in an open-access article by Ravi S. Katari in the Journal of global healthhere and in a short essay by Sasha Zients and Dylan Okabe-Jawdat for the Columbia Political Review (May 2015) here.

And you can find more on the systematic violation of medical neutrality in Bahrein and elsewhere here.